Diego Andres Aguirre

CSU Mentor, Long Beach, California, United States

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Publications (50)43.33 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: CONCLUSION Combined theoretical/on-site programs combined with the latest WEB 2.0 and 3.0 technologies can be key in the training of medical students in diagnostic imaging. BACKGROUND The use of diagnostic imaging has increased significantly on a global scale in the past two decades.Because of this it is essential that medical students acquire more knowledge related to the adequate use of these diagnostic tools, their indications, interpretation of basic findings and patient safety. In Colombia less than 5% of medical schools have a radiology course or clinical rotation. When they do exist, they often end up becoming a rotation where the students sit behind a radiologist listening to him/her dictate studies. EVALUATION We created a live and virtual 6 weeklong course last year medical students at Los Andes University in Bogotá Colombia. This program was created based on the aims and competencies described by AMSER. The students would have a Problem Based Learning (PBL) session and would have to revise academic reviews on a daily basis in addition to clinical rotations divided by sections. At the same time, students had access to platforms based on WEB 2.0 and WEB 3.0 where they would have the possibility of reviewing podcasts of the classes and answer questions in forums based on practical cases of basic pathologies, which would place the student in the midst of learning and generate discussion among peers creating the concept of collective learning. There were a total of 90 participating students between the years 2009-2012. We applied exams at the beginning and end of the course. The mean of the pre-course exam was 24/100 compared to 85/100 for the post-program exam. A complete statistical analysis was done. DISCUSSION It is necessary to create innovative programs for teaching the basics of Diagnostic Imaging to medical students in order for them to acquire an adequate training in the use and interpretation of these tools due to their ample use in the present world. This is very important in order to ensure the adequate use of medical resources by all practitioners and at the same time will result in benefits and greater safety for patients.
    Radiological Society of North America 2013 Scientific Assembly and Annual Meeting; 12/2013
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    ABSTRACT: PURPOSE Facet joint synovial cysts are not unfrequently responsible for chronic back pain; percutaneous CT-guided procedures have become an important tool for treatment of patients with chronic back pain; this study describes the technique, clinical impact, and complications of CT-guided puncture and infiltration of intraspinal facet joint synovial cysts for management of chronic back pain. METHOD AND MATERIALS From Sept-2003 to December-2008, 20 patients with lumbar intraspinal synovial facet joint cysts presenting with chronic back pain were treated percutaneously. CT-guided interventions included a) cyst rupture following direct puncture or pressure injection joint arthrography, and b) infiltration with a combination of steroids and long acting anesthetics. Cyst rupture was confirmed by contrast opacification of the epidural space. Pain intensity was evaluated before and following intervention. Short and long term clinical and imaging follow up was performed. RESULTS 21 lumbar facet joint cysts were treated in 20 patients (12 women, 8 men, mean age 61.3 years); 14 at the L4-L5 level, 6 at L5 - S1 and 1 at L3-L4. Clinical follow up demonstrated short term resolution of pain symptoms in 18/20 patients (78.5%), and long term improvement in 10/14 (85%); imaging follow up demonstrated significant shrinkage/resolution of synovial cysts in respondent patients. Observed time interval for pain relief was 18 months. 2/4 patients with no long term relief required surgery for pain management. No procedure related complications were seen. CONCLUSION CT-guided percutaneous treatment of intraspinal facet joint synovial cysts constitutes an effective therapy for selected patients with chronic back pain contributing to pain control. This series confirms low complication rate, good response and high therapeutic value. This approach should be considered as an alternative treatment for selected patients with chronic back pain. CLINICAL RELEVANCE/APPLICATION CT-guided percutaneous treatment of lumbar intraspinal synovial cysts contributes to pain control in selected patients with chronic back pain and should be considered as an alternative therapy.
    Radiological Society of North America 2009 Scientific Assembly and Annual Meeting; 12/2009
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    ABSTRACT: Cirrhotic livers are characterized by advanced fibrosis and the formation of hepatocellular nodules, which are classified histologically as either (a) regenerative lesions (eg, regenerative nodules, lobar or segmental hyperplasia, focal nodular hyperplasia) or (b) dysplastic or neoplastic lesions (eg, dysplastic foci and nodules, hepatocellular carcinomas). The differentiation of these lesions is important because regenerative nodules are benign, whereas dysplastic and neoplastic nodules are premalignant and malignant, respectively. However, their accurate characterization may be difficult even at histopathologic analysis. Differential diagnosis may be facilitated by comparing the clinical and pathologic findings with radiologic imaging features; in particular, nodule size, vascularity, hepatocellular function, and Kupffer cell density assessed at magnetic resonance (MR) imaging are suggestive of the correct diagnosis. MR imaging is more useful than computed tomography for such assessments because it provides better soft-tissue contrast and a more nuanced depiction of different tissue properties. Moreover, a wider variety of contrast agents is available for use in MR imaging. Familiarity with the MR imaging characteristics of cirrhosis-associated hepatocellular nodules is therefore important for optimal diagnosis and management of cirrhotic disease.
    Radiographics 01/2008; 28(3):747-69. · 2.79 Impact Factor
  • Radiology 12/2006; 241(2):627-8; author reply 628-9. · 6.34 Impact Factor
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    ABSTRACT: To retrospectively evaluate the accuracy of double contrast material-enhanced (hereafter double-enhanced) magnetic resonance (MR) imaging depiction of hepatic fibrosis, with histopathologic analysis findings as the reference standard. The institutional review board approved this HIPAA-compliant study and waived the requirement for informed consent. One hundred one patients (58 men, 43 women; mean age +/- standard deviation, 52 years +/- 10) who underwent double-enhanced MR imaging with superparamagnetic iron oxide (SPIO)-enhanced and double-enhanced spoiled gradient-echo (SPGR) sequences between 2001 and 2004 and had a reliable reference standard for the diagnosis of liver fibrosis were included. Two blinded MR radiologists retrospectively scored qualitative (reticulation, nodularity, and total scores) and quantitative (contrast-to-noise ratio between hyperintense and hypointense liver regions, coefficient of variation, and noise-corrected coefficient of variation) liver texture features on MR images in consensus. The image scores for patients with advanced (METAVIR fibrosis score >/= 3) versus those for patients with mild (METAVIR score </= 2) fibrosis were compared, and receiver operating characteristic curves were determined. Diagnostic performance values were calculated at the optimal operating point. Mann-Whitney U and unpaired Student t tests were performed. Qualitative and quantitative image scores were significantly higher for patients with METAVIR fibrosis scores of 3 or higher than for those with scores of 2 or lower (P < .001); on SPIO-enhanced SPGR images, differences increased with increasing echo time. Diagnostic performance for detection of grade 3 or more severe fibrosis was better with the double-enhanced sequence than with the SPIO-enhanced sequences, and qualitative scores had higher diagnostic performance than quantitative scores. The sensitivity, specificity, and accuracy of qualitative scores on double-enhanced SPGR images were higher than 90%. Advanced hepatic fibrosis can be detected by using double-enhanced MR imaging. Although diagnostic performance depended on the sequence and scoring system used, sensitivity, specificity, and accuracy values higher than 90% were achievable.
    Radiology 06/2006; 239(2):425-37. · 6.34 Impact Factor
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    ABSTRACT: The major classes of contrast agents currently used for magnetic resonance (MR) imaging of the liver include extracellular agents (eg, low-molecular-weight gadolinium chelates), reticuloendothelial agents (eg, ferumoxides), hepatobiliary agents (eg, mangafodipir), blood pool agents, and combined agents. Mechanisms of action, dosage, elimination, toxic effects, indications for use, and MR imaging technical considerations vary according to class. Gadolinium chelates are the most widely used. Ferumoxides are a useful adjunct for detection of hepatocellular carcinoma, particularly when used in combination with gadolinium to achieve improved lesion-to-liver contrast over that achievable with gadolinium alone. Mangafodipir is a prototype hepatobiliary agent that is taken up by lesions with functioning hepatocytes. It may be used for MR cholangiography as well as liver imaging. Although mangafodipir is no longer commercially available in the United States, it is currently marketed and used in Europe. Blood pool agents have not yet been approved for human use in the United States. However, a new combined MR contrast agent, gadobenate dimeglumine, recently was approved, and other agents are in various stages of development.
    Radiographics 01/2006; 26(6):1621-36. · 2.79 Impact Factor
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    ABSTRACT: Fat accumulation is one of the most common abnormalities of the liver depicted on cross-sectional images. Common patterns include diffuse fat accumulation, diffuse fat accumulation with focal sparing, and focal fat accumulation in an otherwise normal liver. Unusual patterns that may cause diagnostic confusion by mimicking neoplastic, inflammatory, or vascular conditions include multinodular and perivascular accumulation. All of these patterns involve the heterogeneous or nonuniform distribution of fat. To help prevent diagnostic errors and guide appropriate work-up and management, radiologists should be aware of the different patterns of fat accumulation in the liver, especially as they are depicted at ultrasonography, computed tomography, and magnetic resonance imaging. In addition, knowledge of the risk factors and the pathophysiologic, histologic, and epidemiologic features of fat accumulation may be useful for avoiding diagnostic pitfalls and planning an appropriate work-up in difficult cases.
    Radiographics 01/2006; 26(6):1637-53. · 2.79 Impact Factor
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    ABSTRACT: To retrospectively determine the frequency and spectrum of findings and recommendations reported with whole-body computed tomographic (CT) screening at a community screening center. This HIPAA-compliant study received institutional review board approval, with waiver of informed consent. The radiologic reports of 1192 consecutive patients who underwent whole-body CT screening of the chest, abdomen, and pelvis at an outpatient imaging center from January to June 2000 were reviewed. Scans were obtained with electron-beam CT without oral or intravenous contrast material. Reported imaging findings and recommendations were retrospectively tabulated and assigned scores. Descriptive statistics were used (means, standard deviations, and percentages); comparisons between subgroups were performed with univariate analysis of variance and chi(2) or Fisher exact tests. Screening was performed in 1192 patients (mean age, 54 years). Sixty-five percent (774 of 1192) were men and 35% (418 of 1192) were women. Nine hundred three (76%) of 1192 patients were self referred, and 1030 (86%) of 1192 subjects had at least one abnormal finding described in the whole-body CT screening report. There were a total of 3361 findings, with a mean of 2.8 per patient. Findings were described most frequently in the spine (1065 [32%] of 3361), abdominal blood vessels (561 [17%] of 3361), lungs (461 [14%] of 3361), kidneys (353 [11%] of 3361), and liver (183 [5%] of 3361). Four hundred forty-five (37%) patients received at least one recommendation for further evaluation. The most common recommendations were for additional imaging of the lungs or the kidneys. With whole-body CT screening, findings were detected in a large number of subjects, and most findings were benign by description and required no further evaluation. Thirty-seven percent of patients had findings that elicited recommendations for additional evaluation, but further research is required to determine the clinical importance of these findings and the effect on patient care.
    Radiology 12/2005; 237(2):385-94. · 6.34 Impact Factor
  • Lily E. Tang, Diego Andres Aguirre, Claude B. Sirlin
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    ABSTRACT: LEARNING OBJECTIVES 1) To review the current role of MR imaging in pre-liver transplant evaluation 2) To discuss how MR findings affect patient management and surgical approach 3) To learn optimal MR techniques for preoperative transplant evaluation. ABSTRACT MR imaging plays an increasingly important role in the preoperative evaluation of orthotopic liver transplant candidates in several liver transplant centers. MR may offer superior sensitivity and specificity for diagnosis of liver pathology that determine liver transplant candidacy. State of the art MR pulse sequences enable comprehensive evaluation of vascular and biliary anatomy and liver parenchyma in a single examination. In this educational exhibit, we will specifically discuss: 1. MR assessment of liver anatomy and anatomic variations that may alter surgical approach or transplant candidacy 2. MR imaging findings that accelerate or exclude liver transplant 3. Optimal MR techniques for pre-operative evaluation 4. Multi-modality imaging and histopathogical correlation.
    Radiological Society of North America 2005 Scientific Assembly and Annual Meeting; 12/2005
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    ABSTRACT: PURPOSE MR image noise is usually estimated by measuring standard deviation (STD) of pixel values in air-containing regions of interest (ROI). This method does not adequately assess noise produced at mid-high fields, where the dominant source of noise is the patient, not the coil; furthermore, noise estimation is influenced by ROI placement and is thus user dependent. We propose a local estimate of noise based on singular value decomposition (SVD) as a possible replacement for the traditional method. METHOD AND MATERIALS The SVD factorizes a signal matrix A into the product of three matrices U*S*V having special properties. By suppressing elements of the diagonal of S (“singular values”) it is possible to control the rank of A and isolate the linear components of the signal from the random contributions of uncorrelated noise. Our method applies the SVD to the neighborhood of each pixel to estimate the noise contribution. The noise values are stored into a map. The STD of an ROI placed on the map can be used as a measure of local noise. Local noise measurements obtained by this method were compared (linear regression) to those obtained with the traditional one on T2/T1w steady state free precession images obtained on a phantom and 10 human volunteers at 1.5T (9 abdomens imaged with phased array coils and one knee with a knee coil). Robustness of the proposed and traditional methods with respect to ROI positioning was assessed by measuring the STD of repeat noise estimates made along the image x- and y-coordinates. RESULTS Noise measured by the proposed method was consistently 0.5-0.6 times that measured by the conventional method (R-squared=0.999). The proposed method was more robust with respect to ROI positioning; STD of repeated measurements using the proposed method was consistently 0.6-0.7 times the STD of the same measurements obtained by the traditional method (R-square=0.993). CONCLUSION Here we propose a new method of estimating local noise on MR images that shows high correlation with the traditional method but is more robust with respect to ROI placement and thus less user dependent. This may permit more reliable signal to noise and contrast to noise ratio measurements.
    Radiological Society of North America 2005 Scientific Assembly and Annual Meeting; 11/2005
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    ABSTRACT: PURPOSE Normal liver tissue accumulates intravenously infused SPIOs and loses signal (SI) on gradient recalled echoes (GREs); fibrotic tissue does not accumulate SPIOs and does not lose SI. On delayed images after Gd administration, fibrotic tissue enhances, further increasing its conspicuity. Thus, on double-contrast enhanced GREs (DEGREs), fibrosis appears as hyperintense reticulations against a dark liver background. Quantitative analysis of liver reticulation is necessary to assess fibrosis objectively. The aim of this study was to identify image texture features that reliably differentiate fibrotic from normal liver on DEGRE images. METHOD AND MATERIALS 45 patients, 23 with advanced fibrosis (METAVIR fibrosis score F3 or F4) and 22 histologically confirmed normals, underwent DEGRE imaging at 1.5T (TR 140/TE 4.5/FA 70/8-10 mm slice thickness/no gaps/32-40 mm FOV/176x256 matrix). Ninety comparably sized regions of interest (ROIs) were placed in representative areas of the 45 livers (2 ROIs/liver) without knowledge of truth standard, avoiding blood vessels. On each ROI, 73 quantitative texture variables were analyzed, including descriptive statistics (mean SI, standard deviation, coefficient of variation, etc.); pixel SI distribution (kurtosis, skewness); image gradient and edge detection; and image information (angular momentum and entropy). Mean values in fibrotic and normal livers were compared (unpaired Student t-tests with Bonferroni–corrected two-tailed alpha levels of 0.0007). Receiver operator characteristics (ROC) and diagnostic performance for differentiation of fibrotic from normal liver were assessed for each variable. RESULTS For all 73 texture variables, mean values were higher in fibrotic than normal livers, 48/73 (66%) significantly. Areas under the ROC curve (AUC) exceeded 0.9 for 38/73 (52%) variables. On these 38 variables, optimal sensitivity/specificity ranged from 90%/85% to 98%/98%. CONCLUSION Liver texture can be assessed quantitatively on DEGRE images to accurately differentiate advanced fibrosis from normal liver. This capability shows promise for noninvasive grading of liver fibrosis. Validation in a large cohort of patients with a spectrum of fibrosis severity is needed.
    Radiological Society of North America 2005 Scientific Assembly and Annual Meeting; 11/2005
  • Diego Andres Aguirre, Sonia Bermudez
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    ABSTRACT: LEARNING OBJECTIVES To discuss diagnostic and therapeutic advantages of image guided infiltrations for management of back pain. To compare CT- versus fluoroscopy-guided spinal procedures for management of back pain. To describe indications, imaging technique and complications of most commonly performed spinal infiltrations for management of back pain using CT-guidance ABSTRACT Chronic back pain constitutes a frequent source of suffering and disability. Spinal infiltrations have a favorable impact in certain pain states, and evidence shows advantages of image-guided infiltrations for management of back pain. Historically, fluoroscopy has been used for image guidance. Now, computed tomography (CT), has assumed a dominant role. CT offers theoretical advantages, such as higher spatial-resolution, potential to use smaller volumes and lower complication rate. Most commonly performed infiltrations include: nerve root, facet joint, epidural and sacro-iliac infiltrations.This exhibit reviews: 1) schematic description of image guided infiltrations; 2) Advantages of CT- over fluoroscopy-guidance spinal infiltrations; 3) Indications, optimal technique, selection of medications, administered doses, and complications for most commonly performed infiltrations. Radiologists should become familiar with these imaging guided procedures which may favorably impact patient care.
    Radiological Society of North America 2005 Scientific Assembly and Annual Meeting; 11/2005
  • Lily E. Tang, Diego Andres Aguirre, Claude B. Sirlin
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    ABSTRACT: LEARNING OBJECTIVES 1) To recognize normal postsurgical anatomy and commonly expected postoperative magnetic resonance (MR) imaging findings after orthotopic liver transplantation (OLT). 2) To describe optimal MR techniques to evaluate patients after OLT. 3) To illustrate the spectrum of intrahepatic and extrahepatic post operative complications after OLT on MR. ABSTRACT MR imaging serves as an invaluable tool in the evaluation of post operative complications following orthotopic liver transplantation (OLT). Adequate knowledge of usual post-transplant surgical anatomy and types of intrahepatic and extrahepatic complications commonly seen on MR is important for early detection of such complications and to allow timely intervention to be performed. This exhibit reviews the MR imaging appearances of expected postoperative findings and common complications after OLT. Emphasis is placed on optimal MR technique and features that permit correct diagnosis and identification of common complications. Correlation with other cross-sectional imaging modalities will also be discussed. Common biliary and vascular complications, intra- and extra-hepatic tumor recurrence, infected and non-infected post-operative collections and abdominal wall complications will be reviewed and a schematic pattern for diagnosis will be presented.
    Radiological Society of North America 2005 Scientific Assembly and Annual Meeting; 11/2005
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    ABSTRACT: LEARNING OBJECTIVES 1. Differentiate simple from closed loop bowel obstruction. 2. Recognize CT imaging features of closed loop bowel obstruction and bowel ischemia. ABSTRACT Closed loop bowel obstruction consists of obstruction of both proximal and distal ends of a segment of bowel, which progresses to intestinal ischemia if diagnosis and surgical intervention are delayed. CT is the imaging modality of choice to establish this diagnosis. This exhibit reviews the etiology, clinical presentation, optimal CT technique, CT imaging features, and complications of closed loop bowel obstruction. In particular, this exhibit highlights the distinctive features of closed loop obstruction that allow differentiation from simple obstruction, and features which identify bowel ischemia with CT imaging.
    Radiological Society of North America 2005 Scientific Assembly and Annual Meeting; 11/2005
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    ABSTRACT: LEARNING OBJECTIVES 1)To review common imaging manifestations of hepatocellular carcinoma (HCC) and related complications as seen on cross sectional imaging techniques. 2)To describe common patterns of spread of HCC and its diagnostic implications. 3)To discuss a rational approach to the differential diagnosis of HCC and its common complications. ABSTRACT HCC is the fifth most common cause of cancer; its incidence is increasing because of the dissemination of hepatitis C and B virus infection. Early and accurate diagnosis of HCC is important since curative treatment is possible for early staged tumors, increasing survival. HCC shows characteristic imaging findings on different cross sectional imaging techniques, typical complications and common patterns of tumoral spread, which are important to establish tumoral extension and guide patient management. By providing pathological correlation, this exhibit reviews the characteristic imaging appearances of HCC on ultrasound, computed tomography and magnetic resonance imaging. It also illustrates the most common complications of HCC such as local and vascular invasion, hemorrhage, perforation, biliary obstruction, tumor recurrence after treatment and their implication for patient prognosis. Finally, we provide an schematic approach for the typical dissemination patterns of HCC.
    Radiological Society of North America 2005 Scientific Assembly and Annual Meeting; 11/2005
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    ABSTRACT: LEARNING OBJECTIVES 1) To learn performance advantages and limitations of useful abdominopelvic MR sequences in the case of non-cooperative patients, with emphasis on ultrafast, non-breath-hold sequences. 2) How to optimize MR imaging parameters to reduce artifacts and optimize scan time, spatial resolution, and signal-to-noise-ratio. ABSTRACT Designing appropriate MR protocols in the case of non-cooperative patients is critical in obtaining a successful MRI examination and in making the correct clinical diagnosis. The development of new, rapid MR pulse sequences has significantly impacted the clinical practice of abdominopelvic MR imaging. This exhibit will explore the performance advantages and limitations of currently available breathing-independent MR pulse sequences, including 2D SS ESE (e.g. HASTE, SSTSE), 2D Ultrafast Magnetization Prepared GRE (e.g. Turbo-FLASH), and 3D spoiled interpolated GRE (e.g. FAME, VIBE). Strategies to optimize MR scanning parameters to reduce artifact and avoid pitfalls will also be discussed. A rational algorithm for choosing the appropriate pulse sequences depending on the clinical scenario, e.g. agitated non-cooperative patient, dyspneic patient, fetal imaging, sedated pediatric patient, will also be presented.
    Radiological Society of North America 2005 Scientific Assembly and Annual Meeting; 11/2005
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    ABSTRACT: To retrospectively identify and describe the imaging features that represent perivascular fatty infiltration of the liver. The institutional review board approved the study and waived informed consent. The study complied with the Health Insurance Portability and Accountability Act. Ten patients (seven women, three men; mean age, 78 years; range, 31-78 years) with fatty infiltration surrounding hepatic veins and/or portal tracts were retrospectively identified by searching the abdominal imaging teaching file of an academic hospital. The patients' medical records were reviewed by one author. Computed tomographic (CT), magnetic resonance (MR), and ultrasonographic (US) imaging studies were reviewed by three radiologists in consensus. Fatty infiltration of the liver on CT images was defined as absolute attenuation less than 40 HU without mass effect and, if unenhanced images were available, as relative attenuation at least 10 HU less than that of the spleen; on gradient-echo MR images, it was defined as signal loss on opposed-phase images compared with in-phase images; and on US images, it was defined as hyperechogenicity of liver relative to kidney, ultrasound beam attenuation, and poor visualization of intrahepatic structures. Perivascular fatty infiltration of the liver was defined as a clear predisposition to fat accumulation around hepatic veins and/or portal tracts. For multiphase CT images, the contrast-to-noise ratio was calculated for comparison of spared liver with fatty liver in each imaging phase. Fatty infiltration surrounded hepatic veins in three, portal tracts in five, and both hepatic veins and portal tracts in two patients. Six of the 10 patients had alcoholic cirrhosis, two reported regular alcohol consumption (one of whom had acquired immunodeficiency syndrome and hepatitis B), one was positive for human immunodeficiency virus, and one had no risk factors for fatty infiltration of the liver. In three of the 10 patients, fatty infiltration was misdiagnosed as vascular or neoplastic disease on initial CT images but was correctly diagnosed on MR images. Perivascular fatty infiltration of the liver has imaging features that allow its recognition.
    Radiology 11/2005; 237(1):159-69. · 6.34 Impact Factor
  • Diego A Aguirre, Sonia Bermudez, Orlando M Diaz
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    ABSTRACT: Image-guided interventional procedures have arisen as an alternative for management of back pain, with controversial indications and efficacy. This study describes the technique, clinical impact, and complications of computed tomography (CT)-guided infiltrations for the management of chronic back pain. One hundred eleven patients with chronic back pain treated with CT-guided infiltrations were studied prospectively. Procedures performed included nerve root, facet joint, epidural, and sacroiliac joint blocks. Pain intensity was evaluated with use of a visual analog scale. Two hundred twenty-two infiltrations were performed in 111 consecutive patients. After 18 months of follow-up, pain improvement lasted for a mean duration of 9 months and the complication rate was less than 1%. Moderate to good pain response was seen in 95% of followed patients and 4% of patients required surgery. Spinal CT-guided infiltration constitutes an effective therapy for chronic back pain. This series confirms a low complication rate, good response, and high therapeutic value.
    Journal of Vascular and Interventional Radiology 06/2005; 16(5):689-97. · 2.00 Impact Factor
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    ABSTRACT: Abdominal wall hernias are a common imaging finding in the abdomen and may be complicated by strangulation, incarceration, or trauma. Because of the risk of developing complications, most abdominal wall hernias are surgically repaired, even if asymptomatic. However, post-surgical complications are also common and include hernia recurrence, infected and noninfected fluid collections, and complications related to prosthetic material. Multi-detector row computed tomography (CT) with its multiplanar capabilities is particularly useful for the evaluation of unrepaired and surgically repaired abdominal wall hernias. Multi-detector row CT provides exquisite anatomic detail of the abdominal wall, thereby allowing accurate identification of wall hernias and their contents, differentiation of hernias from other abdominal masses (tumors, hematomas, abscesses), and detection of pre- or postoperative complications. These findings improve the communication of imaging results to clinicians and help optimize treatment planning. Knowledge of multi-detector row CT findings in unrepaired and surgically repaired abdominal wall hernias and their complications is essential for making the correct diagnosis and may help guide clinical management.
    Radiographics 01/2005; 25(6):1501-20. · 2.79 Impact Factor
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    ABSTRACT: PURPOSE To determine the sensitivity of computed tomography (CT) screening for bowel/mesenteric injuries in blunt abdominal trauma (BAT) patients using water rather than positive enteric contrast material. METHOD AND MATERIALS The trauma registry of a level 1 urban trauma center was retrospectively searched for surgically confirmed bowel/mesenteric injuries in patients who underwent screening CT. During a 6 year period, 1832 patients were scanned with a single detector helical CT, with 7 mm collimation and a pitch of 1.5. Water was given in the resuscitation suite, just prior to transport to CT, to distend the stomach and proximal bowel. No positive enteric contrast was administered. Intravenous contrast material (Optiray 320, Mallinckrodt, St. Louis, MO) was administered at 4 ml/sec (total volume 125 ml). The prospective reports of these studies were then retrospectively reviewed by 2 abdominal radiologists in consensus and compared with surgical results. RESULTS Thirty two patients with confirmed bowel/mesenteric injuries underwent screening CT for BAT. CT was positive for bowel/mesenteric injuries in 20 cases, based on free air (n=3 pts), mesenteric fluid (n=4), unexplained free fluid (n=3), bowel wall thickening (n=1) or more than one of these findings (n=9). CT was indeterminate in 3 cases, 1 of which had definitive CT evidence of a solid organ injury requiring surgical intervention. CT was negative for bowel/mesenteric injuries in 9 cases. All 9 also had other abdominal injuries, 4 of which had definitive CT evidence of solid organ injury necessitating surgical intervention. Therefore, the sensitivity of CT for detection of bowel/ mesenteric injuries was 63% (20/32) and for recognition of injuries requiring surgical intervention 78% (25/32). CONCLUSIONS CT screening for bowel/mesenteric injuries using water as enteric contrast material yields similar sensitivity as previously reported protocols using positive enteric material published in the radiology literature. Comprehensive assessment of diagnostic performance of CT screening using water for enteric distension, including analysis of specificity and accuracy, is ongoing.
    Radiological Society of North America 2004 Scientific Assembly and Annual Meeting; 11/2004

Publication Stats

425 Citations
43.33 Total Impact Points

Institutions

  • 2008
    • CSU Mentor
      Long Beach, California, United States
  • 2006
    • University Hospital Regensburg
      Ratisbon, Bavaria, Germany
  • 2005–2006
    • Naval Medical Center San Diego
      • Department of Radiology
      San Diego, California, United States
  • 2004–2005
    • University of California, San Diego
      • Department of Radiology
      San Diego, CA, United States